Clinical impact of 18F-FDG-PET among memory clinic patients with uncertain diagnosis

Abstract

Purpose: To assess the clinical impact and incremental diagnostic value of ¹⁸F-fluorodeoxyglucose (FDG-PET) among memory clinic patients with uncertain diagnosis.

Methods: The study population consisted of 277 patients who, despite extensive baseline cognitive assessment, MRI, and CSF analyses, had an uncertain diagnosis of mild cognitive impairment (MCI) (n = 177) or dementia (n = 100). After baseline diagnosis, each patient underwent an FDG-PET, followed by a post-FDG-PET diagnosis formulation. We evaluated (i) the change in diagnosis (baseline vs. post-FDG-PET), (ii) the change in diagnostic accuracy when comparing each baseline and post-FDG-PET diagnosis to a long-term follow-up (3.6 ± 1.8 years) diagnosis used as reference, and (iii) comparative FDG-PET performance testing in MCI and dementia conditions.

Results: FDG-PET led to a change in diagnosis in 86 of 277 (31%) patients, in particular in 57 of 177 (32%) MCI and in 29 of 100 (29%) dementia patients. Diagnostic change was greater than two-fold in the sub-sample of cases with dementia "of unclear etiology" (change in diagnosis in 20 of 32 (63%) patients). In the dementia group, after results of FDG-PET, diagnostic accuracy improved from 77 to 90% in Alzheimer's disease (AD) and from 85 to 94% in frontotemporal lobar degeneration (FTLD) patients (p < 0.01). FDG-PET performed better in dementia than in MCI (positive likelihood ratios >5 and < 5, respectively).

Conclusion: Within a selected clinical population, FDG-PET has a significant clinical impact, both in early and differential diagnosis of uncertain dementia. FDG-PET provides significant incremental value to detect AD and FTLD over a clinical diagnosis of uncertain dementia.

Keywords: 18F-Fluorodeoxyglucose-PET; Clinical impact; Dementia; Incremental diagnostic value; Mild cognitive impairment.

Fig. 1

Alluvial diagrams illustrating the change in diagnosis. AD, Alzheimer’s disease; Dem NOS, dementia not otherwise specified; DLB, dementia with Lewy bodies; FTLD, frontotemporal lobar degeneration; MCI, mild cognitive impairment. Changes in diagnosis from pre- to post-FDG-PET imaging, and to the final diagnosis after 3.6 years follow-up time in patients diagnosed with MCI (n = 177) (a) and uncertain dementia diagnoses (n = 100) (b) at baseline.